[Syncrhonous carcinosarcoma of the extrahepatic bile duct and gallbladder.] / Carcinosarcoma sincrónico de la vesícula y la via biliar extrahepática.

Carcinosarcoma is a malignant neoplasm characterized for intermingled epithelial and mesenchymal components. CASE REPORT: A preoperative suspected diagnosis will allow a radical therapy avoiding a very bad prognosis. We report on a male patient who was operated in our Service with diagnosis of synchronous carcinosarcoma of gallbladder and extrahepatic bile duct and a review of the Medical Literature. DISCUSSION: A gallblader carcinosarcoma showing extension into common bile duct is very rare, a carcinosarcoma of the bile duct is exceptional, and a synchronous carcinosarcoma ofthe bile duct and gallbladder has not been reported previously.

Mesenteric tumor due to chronic anisakiasis.

Intestinal anisakiasis is a rare parasitic disease and difficult to diagnose due to symptoms are not specific, so it is considered an underdiagnosed disease. The clinical suspicion with a correct diagnosis of anisakiasis allows the establishment of a correct treatment; in most cases, the resolution is possible with conservative treatment, avoiding unnecessary surgery to the preoperative differential diagnosis of acute abdomen. We report the case of apatient who required urgent surgery secondary to an exacerbation of chronic anisakiasis.

Safety and effectiveness of sucroferric oxyhydroxide in Spanish patients on dialysis: sub-analysis of the VERIFIE study.

BACKGROUND AND AIMS: In this study, we show the results of the subset of Spanish patients of the VERIFIE study, the first post-marketing study assessing the long-term safety and effectiveness of sucroferric oxyhydroxide (SFOH) in patients with hyperphosphatemia undergoing dialysis during clinical practice. PATIENTS AND METHODS: Patients undergoing hemodialysis and peritoneal dialysis with indication of SFOH treatment were included. Follow-up duration was 12-36 months after SFOH initiation. Primary safety variables were the incidence of adverse drug reactions (ADRs), medical events of special interest (MESIs), and variations in iron-related parameters. SFOH effectiveness was evaluated by the change in serum phosphorus levels. RESULTS: A total of 286 patients were recruited and data from 282 were analyzed. Among those 282 patients, 161 (57.1%) withdrew the study prematurely and 52.5% received concomitant treatment with other phosphate binders. ADRs were observed in 35.1% of patients, the most common of which were gastrointestinal disorders (77.1%) and mild/moderate in severity (83.7%). MESIs were reported in 14.2% of patients, and 93.7% were mild/moderate. An increase in ferritin (386.66ng/mL vs 447.55ng/mL; p=0.0013) and transferrin saturation (28.07% vs 30.34%; p=0.043) was observed from baseline to the last visit (p=0.0013). Serum phosphorus levels progressively decreased from 5.69mg/dL at baseline to 4.84mg/dL at the last visit (p<0.0001), increasing by 32.2% the proportion of patients who achieved serum phosphorus levels ≤5.5mg/dL, with a mean daily SFOH dose of 1.98 pills/day. CONCLUSIONS: SFOH showed a favorable effectiveness profile, a similar safety profile to that observed in the international study with most adverse events of mild/moderate severity, and a low daily pill burden in Spanish patients in dialysis.

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.

Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019-11 March 2020) and the COVID era (12 March 2020-30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

Good Practices and Learning Strategies of Undergraduate University Students.

The educational models currently in use in higher education aim to make students active participants in their learning process, while the lecturer is seen more as a facilitator of the said process. Students' learning strategies (superficial approach-memorizing, deep approach-looking for meaning, and achievement approach-aimed at results) and their good practices are gaining in importance and the aim of this study is to identify university students' good practices, which are related to their learning strategies. To do so, our research covered 610 students from different science degree courses at the University of Extremadura who anonymously completed the University Students' Good Practice Inventory (IBPEU) and the University students' Questionnaire to Evaluate Study and Learning Processes (CEPEA). The influence of context, understood here as the center or scientific field, was discarded. The factor 'Actively learning' was positively associated with the deep and achievement approaches; the factor 'Interaction with lecturers' was positively associated with the superficial approach and negatively with the deep approach; the factor 'Cooperative work' was also associated with the deep approach; while the achievement approach was positively associated with the factor 'Optimizing time' and negatively with 'respect for different capacities'. These associations are promising as good practices can be learnt and evaluated.

Prevalence of HCV infection in a health area of Madrid (Spain): The first step towards microelimination. / Prevalencia de la infección por el VHC en un área sanitaria de Madrid: el primer paso para la microeliminación.

OBJECTIVE: To estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated. METHODS: Participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia. RESULTS: Of the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. CONCLUSION: We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.

Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates.

BACKGROUND: Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. METHODS: A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. RESULTS: A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01-1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77-0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17-0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01-5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04-2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02-1.42; p = 0.036). CONCLUSIONS: This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.

A functional disturbance in the auditory cortex related to a low serotonergic neurotransmission in women with type 2 diabetes.

BACKGROUND/AIMS: To determine if the slope of the amplitude/stimulus intensity function (ASF) of the N1/P2 component of the auditory evoked potential was increased in women with type 2 diabetes reflecting a low brain serotonergic activity in the auditory cortex. METHODS: In a comparative study in women with type 2 diabetes and controls, we measured free, bound and total plasma L-tryptophan (L-Trp), neutral amino acids (NAA) and free fatty acids (FFA) and recorded the N1/P2 component of the auditory evoked potential. RESULTS: The diabetic patients were overweight and FFA and NAA in plasma were significantly elevated. The free, bound to albumin and total L-Trp were decreased. The values of free/total L-Trp and free/NAA ratios were significantly lower. The latencies of N1 and P2 at all intensities and the slope ASF of the N1/P2 component significantly increased. CONCLUSION: The decrease of the free fraction of L-Trp in plasma and the increase of the ASF slope of the N1/P2 component reflect a functional relationship between the brain serotonergic activity and the N1/P2 changes in the auditory cortex, suggesting a cortical impaired activity associated with anomalies of brain serotonergic neurotransmission in women with type 2 diabetes. We proposed the ASF slope together with measurement of the plasma FFT as noninvasive clinical indicators of serotonergic neurotransmission in the brain in these as well as in other types of patients.

Costo social de las muertes prematuras por COVID-19 en el Perú / Social cost of premature deaths due to COVID-19 in Peru

Introducción: El costo humano de la pandemia por COVID-19 es significativo, pero el verdadero impacto aún es incierto. Objetivo: Determinar los años de vida potencial perdidos y el costo social por fallecimiento como consecuencia de la enfermedad COVID-19 en la población peruana. Material y Métodos: Se realizó un estudio observacional y descriptivo, mediante el análisis secundario de los fallecimientos por COVID-19 en el Perú entre el 01 de enero del 2020 y el 31 de julio del 2021, reportados por el Ministerio de Salud del Perú. Resultados: Durante el año 2020 se perdieron 926 343,5 años de vida en el Perú; sin embargo, entre el 01 de enero y el 31 de julio del 2021 ya se habían perdido 1 116 553,1 años. Desde el inicio de la pandemia hasta el 31 de julio del 2021, el costo social por fallecimientos a consecuencia de COVID-19 ha ascendido a USD 18 807 942 464,6. Conclusión. La pandemia por COVID-19 ha ocasionado elevada pérdida de años potenciales de vida y alto costo social, principalmente en los territorios urbanos con mayor desarrollo económico.

Background:The human cost of the COVID-19 pandemic is significant, but the true impact is still uncertain. OBJECTIVE: To determine the years of potential life lost and the social cost of death due to the COVID-19 disease in the Peruvian population. : An Material and Methods observational and descriptive study was carried out, through the secondary analysis of deaths due to COVID-19 in Peru between January 1, 2020, and July 31, 2021, reported by the Ministry of Health of Peru.: During Results2020, 926,343.5 years of life were lost in Peru; however, between January 1 and July 31, 2021, 1,116,553.1 years had already been lost. From the start of the pandemic until July 31, 2021, the social cost of deaths due to COVID-19 has amounted to USD 18,807,942,464.6.. The ConclusionCOVID-19 pandemic has caused a high loss of potential years of life and high social cost, mainly in urban territories with higher economic development.

Factores asociados al maltrato físico en menores de cinco años de edad perpetrado por sus progenitoras / Factors Associated with Physical Mistreatment against Children under the Age of Five and Performed by their Mothers

Introducción: El castigo físico en contra del niño dentro del seno familiar y ejercido por la madre es un problema de salud pública en América Latina. Objetivo: Determinar los factores asociados al maltrato físico en menores de cinco años de edad perpetrado por sus madres. Métodos: Se realizó un estudio observacional basado en el análisis secundario de los datos de la Encuesta Nacional de Salud y Demografía (ENDES), 2017. La muestra estuvo conformada por 13 565 niños menores de cinco años. Se calculó el chi cuadrado y el valor de p, así como el odds ratio crudo (ORc) y su intervalo de confianza al 95 por ciento. Resultados: Existió menor riesgo de maltrato en los niños menores de cinco años que resideían en la selva, cuando el esposo o conviviente de la madre vivía en la casa y cuando existía violencia psicológica o física en contra de la mujer. Existió mayor riesgo de maltrato físico cuando las madres hablaban aymara u otra lengua indígena/originaria, cuando la pareja tenía instrucción secundaria o superior o cuando la mujer agredía a su pareja. Conclusiones: La violencia física contra el niño menor de cinco años resultó más probable cuando la madre estaba expuesta a situaciones estresantes, posiblemente mediadas por las condiciones de vulnerabilidad económica o pobreza que vive, sobre todo cuando tenía raíces indígenas y residía en la costa, todo esto exacerbado por la incapacidad para la solución de problemas que, finalmente, derivan en violencia, incluso contra el esposo o conviviente(AU)

Introduction: Physical punishment against the child within the family and performed by her or his mother is a public health concern in Latin America. Objective: To determine the factors associated with physical mistreatment in children under five years of age performed by their mothers. Methods: We carried out an observational study based on the secondary analysis of the data from the 2017 National Survey of Health and Demography (ENDES, as it stands in Spanish for Encuesta Nacional de Salud y Demografía). The sample consisted of 13,565 children under the age of five. Chi square and the P value were calculated, together with the crude odds ratio (ORc) and its 95 percent confidence interval. Results: There was a lower risk of mistreatment in children under the age of five who lived in the jungle, when the mother's husband or partner lived in the house and when there was psychological or physical violence against the woman. There was an increased risk of physical abuse when the mothers spoke Aymara or another indigenous or native language, when the couple had secondary or higher education, or when the woman attacked her partner. Conclusions: Physical violence against children under five years of age was more likely when the mother was exposed to stressful situations, possibly mediated by the conditions of economic vulnerability or poverty that she lives through, especially when she had indigenous roots and lived on the coast, all this exacerbated by the inability to solve problems that ultimately lead to violence, even against the husband or partner(AU)

Fluoxetine treatment of depressed patients with comorbid anxiety disorders.

Major depression with comorbid anxiety disorder is associated with poor antidepressant outcome compared to major depression without comorbid anxiety disorder. The purpose of our study was to assess changes in severity of both depressive and anxiety symptoms in outpatients with major depression with comorbid anxiety disorder following fluoxetine treatment. We enrolled 123 outpatients (mean age 38.9 +/- 10.8 years; 49% women) with major depressive disorder accompanied by one or more current comorbid anxiety disorders in our study. Patients were treated openly with fluoxetine 20 mg/day for 8 weeks. Efficacy assessments included the 17-item Hamilton Rating Scale for Depression (HAM-D) and the patient-rated Symptom Questionnaire (SQ) Scales for Depression and Anxiety. The mood and anxiety disorder modules of the Structured Clinical Interview for DSM-III-R were administered at screen and endpoint. We used 'intent-to-treat' analysis in examining all patients assigned to treatment and completing the baseline visit. The mean number of comorbid anxiety disorders per patient was 1.5 +/- 0.68. The mean HAM-D-17 score and mean Clinical Global Impressions-Severity scores decreased significantly from baseline to endpoint (week 8) following fluoxetine treatment (p < 0.0001). There were significant decreases in all four SQ scale scores, from baseline to endpoint: depression, anxiety, somatic symptoms and anger-hostility (p < 0.0001). Fifty-three percent of patients (n = 65) were depression responders (i.e. > or = 50% decrease in HAM-D-17 score at endpoint) and 46% (n = 57) were remitters (HAM-D-17 < or = 7 at endpoint). Patients with panic disorder had significantly higher baseline HAM-D-17 scores compared to those without panic disorder (p < 0.01). Patients with comorbid obsessive-compulsive disorder (OCD) were significantly less likely to be responders to fluoxetine at endpoint (> or = 50% decrease in HAM-D-17) and to be remitters (HAM-D-17 score of s 7 at endpoint) compared to patients without comorbid OCD (p < 0.01). Of the 41 patients on whom endpoint Structured Clinical Interview for DSM-III-R modules for anxiety disorders were available, 49% (n = 20) no longer met criteria for one or more of their anxiety disorder diagnoses at endpoint. Our preliminary findings suggest that fluoxetine is effective in treating outpatients with major depression with comorbid anxiety disorders, with a significant effect on both depression and anxiety symptoms. Further double-blind, placebo-controlled trials are required in larger samples to confirm our findings.

Violencia extrema contra la mujer y feminicidio en el Perú / Extreme violence against women and femicide in Peru

Objetivo: Determinar la incidencia de violencia extrema contra la mujer y feminicidio así como algunos factores riesgo en el Perú. Métodos: Investigación observacional de datos secundarios (2009-2015) del Ministerio de la Mujer y Poblaciones Vulnerables de Perú. Con el programa Microsoft Excell® se calculó la tasa bruta de violencia extrema contra la mujer y de feminicidio por año y por territorio, así como el riesgo de violencia extrema contra la mujer y el riesgo de feminicidio por territorio, año, mes, vínculo, escenario y área. Resultados: En el período 2009-2015, la tasa de violencia extrema contra la mujer aumentó. Tacna (RT= 2,673; IC 95 por ciento= 2,111-3,384), tuvo el mayor riesgo de feminicidio, mientras que Madre de Dios (RT= 2,475; IC 95 por ciento= 1,462-4,188) tuvo el mayor riesgo de violencia extrema contra la mujer. Este riesgo existió en mayor cuantía en enero (RT=1,204; IC 95 por ciento=1,019-1,422) y el mayor riesgo de feminicidio en noviembre (RT=1,463; IC 95 por ciento=1,173-1,826) y enero (RT=1,280; IC 95 por ciento= 1,014-1,616). Existió mayor riesgo que la violencia extrema contra la mujer culmine en feminicidio cuando el agresor es desconocido (ORc= 11,950; IC 95 por ciento= 6,752-23,510), es conocido (ORc= 2,644; IC 95 por ciento= 1,736-4,094) o es un familiar (ORc=1,614; IC 95 por ciento= 1,078-2,433), en un escenario no íntimo (ORc=5,522; IC 95 por ciento=3,611-8,629), en el área rural (ORc=1,692; IC 95 por ciento=1,136-2,525) o urbana-marginal (ORc=1,678; IC 95 por ciento=1,057-2,673). Conclusiones: La incidencia de violencia extrema contra la mujer ha aumentado. El riesgo de feminicidio es mayor en el mes de noviembre, en el área rural y urbana-marginal, en un escenario no íntimo y cuando la violencia extrema contra la mujer no es perpetrada por la pareja o ex-pareja(AU)

Objective: To determine the incidence of extreme violence against women (EVAW) and femicide; and some risk factors in Peru. Methods: Observational research of secondary data (2009-2015) from the Ministry of Women and Vulnerable Populations of Peru. MS Excell® program was used to calculate the gross rate of extreme violence against women and femicide by territory, year, month, bond, scenario, and area. Results: In the period 2009-2015, the rate of extreme violence against women has increased. Tacna (RT=2,673; IC 95 percent=2,111-3,384) had the highest rate of femicide´s risk, and Madre de Dios (RT=2,475; IC 95 percent= 1,462-4,188) had the highest risk of extreme violence against women. There was greater risk of extreme violence against women in January (RT=1.204, IC95 percent=1.019-1.422) and femicide´s risk in November (RT=1.463, IC95 percent=1.173-1.826) and January (RT=1.280, IC95 percent=1.014-1.616). Extreme violence against women is more likely to end in femicide when the aggressor is unknown (ORc= 11.950; IC 95 percent=6.572-23.510), when is an acquaintance (ORc=2,644; IC 95 percvent=1,736-4,094) or a relative (ORc= 1,614; IC 95 percent= 1,078-2,433), in a non-intimate place (ORc= 5,522; IC 95 percent= 3,611-8,629), in the rural area (ORc= 1,692; IC 95 percent= 1,136-2,525), or in the marginal urban area (ORc=1,678; IC 95 percent= 1,057-2,673). Conclusions: Extreme violence against women's incidence has increased. The risk of femicide is higher in November, in the rural and marginal urban areas, in a non-intimate scenario, and when the extreme violence against women is not perpetrated by the partner or ex-partner(AU)

Factores predictores de mortalidad y estrategias de detección precoz de síndrome hepatopulmonar en pacientes trasplantados hepáticos / Predictors of mortality and early detection strategies for hepatopulmonary syndrome in liver transplant patients

Introduction: Hepatopulmonary syndrome (HPS) is a serious, progressive disease. Its pathophysiology resides in a hypoxic intrapulmonary shunt and severe clinical deterioration. Liver transplantation (LT) is the only effective treatment in appropriately selected patients. Objective: To acknowledge the importance of early diagnosis of HPS. Patients and methods: Observational, descriptive, retrospective trial including 8 patients with HPS that received LT between April 2006 and August 2014. The clinical data prior to transplantation and follow-up after the procedure were reviewed. A multivariate analysis (stepwise forward logistic regression analysis) was used to identify the variable that could potentially increase the risk of death. Results: Of the 8 patients, death could only be significantly predicted based on the pre-LT arterial blood partial oxygen pressure (PaO2) (p = 0.002). The average pre-LT PaO2 of the patients that died was 51.5 ±2.49 SD, with a statistically significant difference (p = 0.002). None of the variables was statistically significant for HPS reversibility. The survival rate of patients diagnosed with HPS following the LT was 62.5%. Conclusions: The level of pre-LT hypoxemia is an important predictor for immediate postoperative mortality. Early detection of the condition is critical to reduce the post LT morbidity and mortality so that the indication for transplant is made at the right time, regardless of the stage of liver disease. The most efficient clinical strategy could be the use of appropriate early detection protocols for HPS through screening of hypoxemia in patients with portal hypertension.

Introducción: El síndrome hepatopulmonar (SHP) es una enfermedad grave y progresiva cuya fisiopatología reside en un shunt intrapulmonar con hipoxia y deterioro clínico severo. Como único tratamiento efectivo se ha postulado el trasplante hepático (TH), en pacientes adecuadamente seleccionados. Objetivo: Reconocer la importancia del diagnostico temprano del SHP. Pacientes y métodos: Mediante un estudio observacional, descriptivo, con carácter retrospectivo de 8 pacientes con SHP, a los que se les realizó TH en el período entre Abril 2006-Agosto 2014. Se han revisado los datos clínicos previos al trasplante y el seguimiento tras este. Se empleó un estudio multivariante (stepwise forward logistic regression analisis), para determinar cual variable podría incrementar el riesgo de muerte. Resultados: De los 8 pacientes, el resultado de muerte sólo pudo ser predicho significativamente por el factor presión parcial de oxígeno en sangre arterial (PaO2) pre-TH (p=0,002). La PaO2 pre-TH promedio de los pacientes que fallecieron era de 51,5 +/- 2,49 DS, siendo la diferencia estadísticamente significativa (p=0,002). Ninguna variable resultó estadísticamente significativa para reversibilidad del SHP. La supervivencia de los pacientes con criterio de SHP posterior al TH fue de 62,5%. Conclusiones: El grado de hipoxemia pre-TH es un factor predictor importante de mortalidad en el postoperatorio inmediato. La precocidad en la detección de la entidad es fundamental tanto para disminuir la morbimortalidad post TH como para indicar éste en el momento óptimo independientemente del estadío de la enfermedad hepática. Protocolos adecuados de detección precoz del SHP mediante screening de hipoxemias en pacientes con hipertensión portal, puede ser la estrategia clínica más eficiente.

[Digital acrometastasis]. / Metástasis digital acral.

Cutaneous metastases are infrequent and in some cases represent the first manifestation of an unknown neoplasm. Acrally located metastases are particularly rare, and the prognosis is very poor, with a survival time of only a few months. Although the clinical presentation varies, they are generally confused with an infectious or inflammatory process, which delays diagnosis. When they are located on the fingers, the most frequent cause is lung carcinoma, while those located on the toes are usually due to tumors in the genitourinary tract. The histology of the metastasis is similar to that of the primary tumor, although less differentiated. In most acrometastases, first the bone and then the skin are affected. Treatment is palliative. We present the case of a patient with a metastasis on the big toe as an initial sign of a previously unknown lung tumor.

[Cutaneous epithelioid hemangioendothelioma]. / Hemangioendotelioma epitelioide cutáneo.

Epithelioid hemangioendothelioma is a rare vascular tumor of intermediate aggressiveness, which usually appears in adults. It generally affects soft tissues and, less frequently, the lungs and liver. Diagnosis is by histological evaluation, and the epithelioid appearance of the neoplastic endothelial cells is typical, as is the tendency to form vascular channels. Treatment is surgical excision, with broad margins. This tumor may in exceptional cases affect the skin, with few cases having been described in literature. We describe the case of a male patient with plantar epithelioid hemangioendothelioma, and we review the literature.

[Superficial angiomyxoma]. / Angiomixoma superficial.

Superficial angiomyxomas are clinically variable, infrequent, benign skin lesions. They are usually located on the trunk, but can also appear on the lower limbs, head and neck. They are diagnosed histologically, and are characterized by the fact that they are poorly delimited, multinodular tumors, and by the presence of interstitial myxoid material with scanty cellularity. Treatment is through surgery, and local recurrence is possible. An associated Carney's complex must always be ruled out with superficial angiomyxoma. We present the case of a woman with a solitary, fast-growing superficial angiomyxoma.

Evolución de pacientes con diabetes mellitus en diálisis peritoneal / Outcomes in diabetic patients treated with peritoneal dialysis

En la actualidad, la nefropatía diabética se ha convertido en la primera causa de ingreso en programas de tratamiento sustitutivo renal en los países desarrollados. Este impacto de la diabetes se mantiene a lo largo del seguimiento de los pacientes, de forma tal que los resultados del tratamiento con diálisis en la población con diabetes son inferiores a los de la población no diabética. La diálisis peritoneal es una alternativa en el tratamiento de la enfermedad renal crónica, con ciertas ventajas para el paciente diabético en relación con la mejor preservación de la función renal residual, mejor estabilidad hemodinámica, la no necesidad de creación de acceso vascular para la conexión a la diálisis y las que se derivan de su carácter de técnica domiciliaria. La comorbilidad asociada con la diabetes mellitus, sobre todo cardiovascular, se refleja en un mayor número de ingresos hospitalarios, menor supervivencia y una tasa más alta de infecciones peritoneales, sobre todo en pacientes con diabetes tipo 2. En esta revisión se analizan los resultados de los estudios publicados de supervivencia de pacientes con diabetes mellitus en diálisis peritoneal...

Significado de ser licenciada en enfermería después de curso complementario y su tranferencia a la práctica / Meaning of being a graduate in nursing after a complementary course and transfer to practice / Significado de ser graduado em enfermagem após um curso complementar e transferir para a prática

La presente tesis explora el significado que tienen un grupo de enfermeras quienes realizaron curso complementario para ser licenciadas en Enfermería e identificar si reconocen la transferencia de éste a su práctica profesional. Se partió del supuesto que las enfermeras que realizan curso complementario modifican su significado de ser licenciadas en Enfermería, al haber modificaciones en el significado, se espera que modifiquen su hacer como profesional de esta disciplina. Se llevó a cabo una investigación de tipo cualitativa, fenomenología, con una unidad de análisis de siete informantes, a quienes se les aplicó una entrevista semiestructura con cuatro preguntas base. La entrevista fue grabada en audio previo consentimiento informado y transcrita de forma individual, respetando la confidencialidad e identificación de cada informante. De los datos obtenidos, se identificaron conceptos que dieron origen a las categorías: La Enfermería como profesión y estudios complementarios. En la primera categoría, las informantes expresan los motivos que tuvieron para ser enfermeras, el estatus que tiene actualmente de profesión, cómo es su práctica profesional, hablan de la necesidad de contar con conocimientos propios y prestados en la profesión. De la segunda categoría especificaron los motivos que tuvieron para realizar estudios complementarios, cómo fue para ellas este sistema educativo, los logros que ellas reconocen y las dificultades a las que se enfrentaron al realizar este tipo de estudios. Como conclusiones se obtuvo que ser licenciada en Enfermería está representado para las informantes obtener una profesión. En los cursos complementarios se aprenden conocimientos nuevos y se logran cambios en el ser y hacer que han sido difíciles de aplicar en su práctica.

This thesis explores the meaning of a group of nurses who completed a complementary course to be licensed in Nursing and identify if they recognize the transfer of this to their professional practice. It was assumed that the nurses who complete the complementary course modify their meaning of being licensed in Nursing, since there are changes in the meaning, they are expected to modify their work as a professional in this discipline. A qualitative research, phenomenology was carried out, with a unit of analysis of seven informants, who were given a semi-structured interview with four basic questions. The interview was recorded in audio with prior informed consent and transcribed individually, respecting the confidentiality and identification of each informant. From the data obtained, concepts that gave rise to the categories were identified: Nursing as a profession and complementary studies. In the first category, the informants express the reasons they had for being nurses, the status they currently have of profession, how is their professional practice, they speak of the need to have their own knowledge and loaned in the profession. From the second category, they specified the reasons they had to carry out complementary studies, how this educational system was for them, the achievements they recognize and the difficulties they faced when carrying out this type of study. As conclusions, it was obtained that being licensed in Nursing is represented for informants obtaining a profession. In the complementary courses new knowledge is learned and changes are achieved in the being and doing that have been difficult to apply in their practice.

Esta tese explora o significado de um grupo de enfermeiros que completou um curso complementar a ser licenciado em Enfermagem e identifica se reconhece a transferência deste para sua prática profissional. Assumiu-se que os enfermeiros que concluem o curso complementar modificam o seu significado de ser licenciado em Enfermagem, uma vez que há mudanças no significado, espera-se que modifiquem seu trabalho como profissional nesta disciplina. Foi realizada uma pesquisa qualitativa, com fenomenologia, com uma unidade de análise de sete informantes, que receberam uma entrevista semiestruturada com quatro questões básicas. A entrevista foi gravada em áudio com consentimento prévio informado e transcrita individualmente, respeitando a confidencialidade e identificação de cada informante. A partir dos dados obtidos, identificaram-se conceitos que originaram as categorias: Enfermagem como profissão e estudos complementares. Na primeira categoria, os informantes expressam os motivos que tinham para serem enfermeiros, o status que possuem atualmente de profissão, como está sua prática profissional, falam da necessidade de ter conhecimento próprio e emprestado na profissão. A partir da segunda categoria, especificaram as razões pelas quais tiveram que realizar estudos complementares, como esse sistema educacional era para eles, as conquistas que reconhecem e as dificuldades que enfrentavam ao realizar esse tipo de estudo. Como conclusões, obteve-se que ser licenciado em Enfermagem é representado por informantes que obtêm uma profissão. Nos cursos complementares, novos conhecimentos são aprendidos e mudanças são alcançadas no ser e no fazer, que têm sido difíceis de aplicar em sua prática.

La autoevaluación de la organización académica de la Facultad de Enfermería de la Universidad Nacional San Luis Gonzaga de Ica 2003-2004 / The self-evaluation of the academic organization of the Faculty of Nursing of the National University San Luis Gonzaga de Ica 2003-2004

Las palabras calidad y evaluación constituyen actualmente dos conceptos verdaderamente importantes para las organizaciones modernas, las cuales cada vez más los integran a su filosofía de trabajo. El presente trabajo de investigación, se basa en la autoevaluación de la organización académica de la Facultad de Enfermería de la Universidad Nacional "San Luís Gonzaga" de lca, investigación de tipo descriptivo, evaluativo. Se utilizó como instrumento la encuesta, que se aplicó a 58 docentes y 387 alumnos; la calificación de la observación directa de los documentos y la posterior asignación de los puntajes para la autoevaluación, se hizo en base a la Guía de Evaluación y Calificación propuesta por la autora de la tesis, llegando a las siguientes conclusiones: El currículo, el sistema de evaluación general; los recursos humanos; la calidad de la investigación, la infraestructura de la organización académica de la Facultad de Enfermería de la Universidad Nacional "San Luís Gonzagaõ de Ica; son Buenos (57.54) medido mediante un proceso de autoevaluación. Se concluye que el promedio porcentual, que se considera para ambos grupos es BUENO (57.54), que coincide con la Hipótesis del estudio que consideraba que: "El nivel de Organización Académica de la Facultad de Enfermería. Universidad Nacional "San Luis Gonzaga" de lca. 2003-2004, medido mediante un proceso de autoevaluación, es bueno...

Nowadays the words quality and assessment are two very important concepts in modem organizations, which use them more and more to its work philosophy. The present research study is based on the academic organization of the Faculty of Nursing self-assessment at San Luis Gonzaga National University. This is a descriptive assessment research type. A survey applied to 58 professors and 387 students was used as the instrument. Direct observation qualification of documents and the subsequent awarding of points based on the Assessment and Qualification Guide were proposed by the author of this thesis for the program self assessment to accreditation. The following conclusions were reached: The curricula, The General Assessemnt System, Human Resources, the Quality of the Research and the Academic Organization Infrastructure of the Faculty of Nursing at San Luis Gonzaga National University of lca are good (57.54) after a self-assessment. In conclusion, the percentual average considered for both groups has good (57.54), coinciding with the hypothesis of study which considers that "The academic organization of the Faculty of Nursing at San Luis Gonzaga National University 2003-2004, measured through a self assessment process is good...

Indice biespectral del electroencefalogrma en pacientes bajo anestesia con propofol Hospital Escuela Antonio Lenín Fonseca, agosto 2000-enero 2001 / Bispectral index of electroencephalogram in patients under anesthesia with propofol, Hospital Escuela Antonio Lenín, august 2000 to january 2001

El presente estudio se realizó en el Hospital Escuela Antonio Lenín Fonseca, es de tipo descriptivo de corte transversal, con el fin de establecer la relación entre el indice Biespectral del Electroencefalograma y un protocolo de anestesia con propofol, en pacientes adultos sometidos a cirugías electivas (colecistectomía). Se incluyeron en el estudio 51 pacientes ASA y II, con su rango de edad de 18 a 75 años y peso de 44 a 88 kg. El Propofol utilizadoen una dosis de inducción de 2 mg/kg y una dosis de mantenimiento de 100 mcg/kg/min. Se logro establecer que la dosis de 2 mg/kg de propofol para la inducción anestésica la relación entre los valores de BIS y dicha dosis son inversamente proporcionales, encontrando que el 71 porciento de los pacientes obtuvieron un profundo estado hipnótico (BIS de 59-40), o sea un BIS óptimo en anestesia general.Posteriormente cn la dosis de mantenimiento de propofol (100 mcg/kg/min) se observó un comportamiento dosis/tiempo/dependiente, es decir los valores de BIS obtenidos en la muestra de pacientes dependieron de la dosis de mantenimiento estándar propuesta y el tiempo que esta dosis fue mantenida para logar el estado hipnótico. Al evaluar la relación entre los valores de BIS con presión arterial media(PAM) y frecuencia cardíaca (FC), se observó que la relación entre los valores de PAM con los valores de BIS sufrieron cambios no significativos desde los cvalores de inducción hasta los primeros 45 a 50 minutos de anestesia. De igual manera la frecuencia cardíaca sufrió cambios ligeros, no significativos desde la inducción hasta los 55 minutos de anestesia, que no se relacionan singnificativamente con los valores de BIS y por lo tanto del estado hipnótico que se mantiene en el transanestésico...